Saving Our Patients From Themselves

As I prepare for my addiction medicine boards later this year, I am sharply reminded of the enormous undiagnosed burden of alcohol abuse in primary care. Nearly one-fourth of Americans over the age of 12 years report binge drinking (consuming 5 or more alcoholic drinks on one occasion) and 7% report regular heavy drinking. Alcohol is the third leading cause of preventable death in the United States after tobacco and obesity. Half of alcohol-related deaths are due to acute effects (e.g., accidents, poisoning) and half are due to chronic effects (e.g., cirrhosis, cardiomyopathy). Despite the tremendous disease toll, time limitations and the absence of readily accessible resources for addressing high-risk alcohol use behaviors are the unhappy clinical reality.

A recent editorial in The American Journal of Addictions reminds us of an effective, evidence-based care model designed to assess and address substance use disorders known as SBIRT (Screening, Brief Intervention, Referral, and Treatment). The authors point out that a single question screener, “In the past year, have you had any times when you had 5 (for women, 4) or more drinks at one sitting?” is 84% sensitive and 78% specific for hazardous drinking, and 88% sensitive and 66% specific for current alcohol use disorders. Substantial evidence exists for the effectiveness of brief interventions for reducing harmful drinking when delivered by a physician or other health professional. In a study including roughly 500,000 participants, SBIRT resulted in a 39% decline in heavy alcohol use at 6 months.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines the SBIRT model as involving a brief intervention of 5-10 minutes in duration triggered by universal screening delivered in a nonsubstance abuse treatment setting. Both the screening and counseling are reimbursable.  

So where do we go from here? We could all consider a universal screener for problem drinking on intake forms for new and established patients. Interested clinicians can learn more about brief alcohol interventions and can obtain tools kits and forms online for free.

SAMSHA provides a treatment facility locator that includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. This information is maintained and updated by the U.S. Department of Health and Human Services. Early identification of problem drinking provides the greatest opportunity for changing a patient’s future and reducing alcohol-related morbidity and mortality down the road.

Dr. Ebbert reported having no relevant conflicts of interest.   

As I prepare for my addiction medicine boards later this year, I am sharply reminded of the enormous undiagnosed burden of alcohol abuse in primary care. Nearly one-fourth of Americans over the age of 12 years report binge drinking (consuming 5 or more alcoholic drinks on one occasion) and 7% report regular heavy drinking. Alcohol is the third leading cause of preventable death in the United States after tobacco and obesity. Half of alcohol-related deaths are due to acute effects (e.g., accidents, poisoning) and half are due to chronic effects (e.g., cirrhosis, cardiomyopathy). Despite the tremendous disease toll, time limitations and the absence of readily accessible resources for addressing high-risk alcohol use behaviors are the unhappy clinical reality.

A recent editorial in The American Journal of Addictions reminds us of an effective, evidence-based care model designed to assess and address substance use disorders known as SBIRT (Screening, Brief Intervention, Referral, and Treatment). The authors point out that a single question screener, “In the past year, have you had any times when you had 5 (for women, 4) or more drinks at one sitting?” is 84% sensitive and 78% specific for hazardous drinking, and 88% sensitive and 66% specific for current alcohol use disorders. Substantial evidence exists for the effectiveness of brief interventions for reducing harmful drinking when delivered by a physician or other health professional. In a study including roughly 500,000 participants, SBIRT resulted in a 39% decline in heavy alcohol use at 6 months.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines the SBIRT model as involving a brief intervention of 5-10 minutes in duration triggered by universal screening delivered in a nonsubstance abuse treatment setting. Both the screening and counseling are reimbursable.  

So where do we go from here? We could all consider a universal screener for problem drinking on intake forms for new and established patients. Interested clinicians can learn more about brief alcohol interventions and can obtain tools kits and forms online for free.

SAMSHA provides a treatment facility locator that includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. This information is maintained and updated by the U.S. Department of Health and Human Services. Early identification of problem drinking provides the greatest opportunity for changing a patient’s future and reducing alcohol-related morbidity and mortality down the road.

Dr. Ebbert reported having no relevant conflicts of interest.   

As I prepare for my addiction medicine boards later this year, I am sharply reminded of the enormous undiagnosed burden of alcohol abuse in primary care. Nearly one-fourth of Americans over the age of 12 years report binge drinking (consuming 5 or more alcoholic drinks on one occasion) and 7% report regular heavy drinking. Alcohol is the third leading cause of preventable death in the United States after tobacco and obesity. Half of alcohol-related deaths are due to acute effects (e.g., accidents, poisoning) and half are due to chronic effects (e.g., cirrhosis, cardiomyopathy). Despite the tremendous disease toll, time limitations and the absence of readily accessible resources for addressing high-risk alcohol use behaviors are the unhappy clinical reality.

A recent editorial in The American Journal of Addictions reminds us of an effective, evidence-based care model designed to assess and address substance use disorders known as SBIRT (Screening, Brief Intervention, Referral, and Treatment). The authors point out that a single question screener, “In the past year, have you had any times when you had 5 (for women, 4) or more drinks at one sitting?” is 84% sensitive and 78% specific for hazardous drinking, and 88% sensitive and 66% specific for current alcohol use disorders. Substantial evidence exists for the effectiveness of brief interventions for reducing harmful drinking when delivered by a physician or other health professional. In a study including roughly 500,000 participants, SBIRT resulted in a 39% decline in heavy alcohol use at 6 months.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines the SBIRT model as involving a brief intervention of 5-10 minutes in duration triggered by universal screening delivered in a nonsubstance abuse treatment setting. Both the screening and counseling are reimbursable.  

So where do we go from here? We could all consider a universal screener for problem drinking on intake forms for new and established patients. Interested clinicians can learn more about brief alcohol interventions and can obtain tools kits and forms online for free.

SAMSHA provides a treatment facility locator that includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. This information is maintained and updated by the U.S. Department of Health and Human Services. Early identification of problem drinking provides the greatest opportunity for changing a patient’s future and reducing alcohol-related morbidity and mortality down the road.

Dr. Ebbert reported having no relevant conflicts of interest.